In 2003, a Committee of the Institute of Medicine of the National Academy of Sciences summarized hundreds of studies documenting that US racial minorities, especially African Americans, receive ...poorer quality health care for a wide variety of conditions than their White counterparts. These racial differences in health care persist after controlling for sociodemographic factors and patients' ability to pay for care. The Committee concluded that physicians' unconscious negative stereotypes of African Americans, and perhaps other people of color, likely contribute to these health care disparities. This paper selectively reviews studies published after 2003 on the likely contribution of physicians' unconscious bias to US health care disparities. All studies used the Implicit Association Test which quantifies the relative speed with which individuals associate positive attributes like "intelligent" with Whites compared to Blacks or Latino/as. In addition to assessing physicians' unconscious attitudes toward patients, some studies focused on the behavioral and affective dimensions of doctor-patient communication, such as physicians' "verbal dominance" and whether patients felt respected. Studies reviewed found a "pro-white" unconscious bias in physicians' attitudes toward and interactions with patients, though some evidence suggests that Black and female physicians may be less prone to such bias. Limited social contact between White physicians and racial/ethnic minorities outside of medical settings, plus severe time pressures physicians often face during encounters with patients who have complex health problems could heighten their susceptibility to unconscious bias.
John Cassel's 1976 paper "The Contribution of the Social Environment to Host Resistance" (Am J Epidemiol. 1976;104(2):107-123) is widely regarded as a classic in epidemiology. He makes the compelling ...argument that the quality of a person's social relationships, that is, the degree to which her relationships are more stressful than supportive (or vice versa) influences her susceptibility to disease independent of genetic endowment, diet, physical activity, etc. Cassel's provocative thesis was anchored in a cogent synthesis of findings from animal experiments and observational studies on diverse human populations. Beginning in the late 1970s, the paper stimulated an explosion of epidemiologic research on social support and human health. Beyond advancing epidemiologic theory, Cassel showed how findings from various epidemiologic study designs could be marshalled to build a persuasive causal argument that impaired social bonds increase the risk of premature disease and death. The paper also foreshadowed core ideas of later theoretical constructs, such as weathering and allostatic load, regarding the power of chronic environmental stressors to accelerate biological aging across multiple organ systems. Cassel's assessment of the research and practice implications of his conclusions has remarkable contemporary resonance for the field of epidemiology.
The present study used synchronous video conferencing to remotely deliver a behavioral skills training‐based (BST) parent training program to 3 parents of children with autism in the family home. ...Parents were taught to implement graduated guidance to teach their children several important self‐care skills. Parents did not correctly implement graduated guidance after receiving detailed written instructions only. After parents received the BST parent training package, however, all parents implemented graduated guidance with near‐perfect levels of fidelity, and all children completed the targeted self‐care skills with substantially higher levels of accuracy and independence. Furthermore, parents reported high levels of satisfaction with graduated guidance, the telehealth BST training package, and their children's ability to complete self‐care skills.
Aerosol optical properties measured at Appalachian State University's co-located NASA AERONET and NOAA ESRL aerosol network monitoring sites over a nearly four-year period (June 2012–Feb 2016) are ...used, along with satellite-based surface reflectance measurements, to study the seasonal variability of diurnally averaged clear sky aerosol direct radiative effect (DRE) and radiative efficiency (RE) at the top-of-atmosphere (TOA) and at the surface. Aerosol chemistry and loading at the Appalachian State site are likely representative of the background southeast US (SE US), home to high summertime aerosol loading and one of only a few regions not to have warmed during the 20th century. This study is the first multi-year ground truth DRE study in the SE US, using aerosol network data products that are often used to validate satellite-based aerosol retrievals. The study is also the first in the SE US to quantify DRE uncertainties and sensitivities to aerosol optical properties and surface reflectance, including their seasonal dependence.Median DRE for the study period is −2.9 W m−2 at the TOA and −6.1 W m−2 at the surface. Monthly median and monthly mean DRE at the TOA (surface) are −1 to −2 W m−2 (−2 to −3 W m−2) during winter months and −5 to −6 W m−2 (−10 W m−2) during summer months. The DRE cycles follow the annual cycle of aerosol optical depth (AOD), which is 9 to 10 times larger in summer than in winter. Aerosol RE is anti-correlated with DRE, with winter values 1.5 to 2 times more negative than summer values. Due to the large seasonal dependence of aerosol DRE and RE, we quantify the sensitivity of DRE to aerosol optical properties and surface reflectance, using a calendar day representative of each season (21 December for winter; 21 March for spring, 21 June for summer, and 21 September for fall). We use these sensitivities along with measurement uncertainties of aerosol optical properties and surface reflectance to calculate DRE uncertainties. We also estimate uncertainty in calculated diurnally-averaged DRE due to diurnal aerosol variability. Aerosol DRE at both the TOA and surface is most sensitive to changes in AOD, followed by single-scattering albedo (ω0). One exception is under the high summertime aerosol loading conditions (AOD ≥ 0.15 at 550 nm), when sensitivity of TOA DRE to ω0 is comparable to that of AOD. Aerosol DRE is less sensitive to changes in scattering asymmetry parameter (g) and surface reflectance (R). While DRE sensitivity to AOD varies by only ∼ 25 to 30 % with season, DRE sensitivity to ω0, g, and R largely follow the annual AOD cycle at APP, varying by factors of 8 to 15 with season. Since the measurement uncertainties of AOD, ω0, g, and R are comparable at Appalachian State, their relative contributions to DRE uncertainty are largely influenced by their (seasonally dependent) DRE sensitivity values, which suggests that the seasonal dependence of DRE uncertainty must be accounted for. Clear sky aerosol DRE uncertainty at the TOA (surface) due to measurement uncertainties ranges from 0.45 (0.75 W m−2) for December to 1.1 (1.6 W m−2) for June. Expressed as a fraction of DRE computed using monthly median aerosol optical properties and surface reflectance, the DRE uncertainties at TOA (surface) are 20 to 24 % (15 to 22 %) for March, June, and September and 49 (50 %) for DEC. The relatively low DRE uncertainties are largely due to the low uncertainty in AOD measured by AERONET. Use of satellite-based AOD measurements by MODIS in the DRE calculations increases DRE uncertainties by a factor of 2 to 5 and DRE uncertainties are dominated by AOD uncertainty for all seasons. Diurnal variability in AOD (and to a lesser extent g) contributes to uncertainties in DRE calculated using daily-averaged aerosol optical properties that are slightly larger (by ∼ 20 to 30 %) than DRE uncertainties due to measurement uncertainties during summer and fall, with comparable uncertainties during winter and spring.
Knowledge of aerosol size and composition is important for determining radiative forcing effects of aerosols, identifying aerosol sources and improving aerosol satellite retrieval algorithms. The ...ability to extrapolate aerosol size and composition, or type, from intensive aerosol optical properties can help expand the current knowledge of spatiotemporal variability in aerosol type globally, particularly where chemical composition measurements do not exist concurrently with optical property measurements. This study uses medians of the scattering Ångström exponent (SAE), absorption Ångström exponent (AAE) and single scattering albedo (SSA) from 24 stations within the NOAA/ESRL Federated Aerosol Monitoring Network to infer aerosol type using previously published aerosol classification schemes.Three methods are implemented to obtain a best estimate of dominant aerosol type at each station using aerosol optical properties. The first method plots station medians into an AAE vs. SAE plot space, so that a unique combination of intensive properties corresponds with an aerosol type. The second typing method expands on the first by introducing a multivariate cluster analysis, which aims to group stations with similar optical characteristics and thus similar dominant aerosol type. The third and final classification method pairs 3-day backward air mass trajectories with median aerosol optical properties to explore the relationship between trajectory origin (proxy for likely aerosol type) and aerosol intensive parameters, while allowing for multiple dominant aerosol types at each station.The three aerosol classification methods have some common, and thus robust, results. In general, estimating dominant aerosol type using optical properties is best suited for site locations with a stable and homogenous aerosol population, particularly continental polluted (carbonaceous aerosol), marine polluted (carbonaceous aerosol mixed with sea salt) and continental dust/biomass sites (dust and carbonaceous aerosol); however, current classification schemes perform poorly when predicting dominant aerosol type at remote marine and Arctic sites and at stations with more complex locations and topography where variable aerosol populations are not well represented by median optical properties. Although the aerosol classification methods presented here provide new ways to reduce ambiguity in typing schemes, there is more work needed to find aerosol typing methods that are useful for a larger range of geographic locations and aerosol populations.
Anticipating the need to evaluate and integrate scientific evidence to inform new risk assessments or to update existing risk assessments, the Formaldehyde Panel of the American Chemistry Council ...(ACC), in collaboration with the University of North Carolina, convened a workshop: “Understanding Potential Human Health Cancer Risk - From Data Integration to Risk Evaluation” in October 2017. Twenty-four (24) invited-experts participated with expertise in epidemiology, toxicology, science integration and risk evaluation. Including members of the organizing committee, there were 29 participants. The meeting included eleven presentations encompassing an introduction and three sessions: (1) “integrating the formaldehyde science on nasal/nasopharyngeal carcinogenicity and potential for causality”; (2) “integrating the formaldehyde science on lymphohematopoietic cancer and potential for causality; and, (3) “formaldehyde research-data suitable for risk assessment”. Here we describe key points from the presentations on epidemiology, toxicology and mechanistic studies that should inform decisions about the potential carcinogenicity of formaldehyde in humans and the discussions about approaches for structuring an integrated, comprehensive risk assessment for formaldehyde. We also note challenges expected when attempting to reconcile divergent results observed from research conducted within and across different scientific disciplines - especially toxicology and epidemiology - and in integrating diverse, multi-disciplinary mechanistic evidence.
We evaluated the spatial accessibility of large "chain" supermarkets in relation to neighborhood racial composition and poverty.
We used a geographic information system to measure Manhattan block ...distance to the nearest supermarket for 869 neighborhoods (census tracts) in metropolitan Detroit. We constructed moving average spatial regression models to adjust for spatial autocorrelation and to test for the effect of modification of percentage African American and percentage poor on distance to the nearest supermarket.
Distance to the nearest supermarket was similar among the least impoverished neighborhoods, regardless of racial composition. Among the most impoverished neighborhoods, however, neighborhoods in which African Americans resided were, on average, 1.1 miles further from the nearest supermarket than were White neighborhoods.
Racial residential segregation disproportionately places African Americans in more-impoverished neighborhoods in Detroit and consequently reduces access to supermarkets. However, supermarkets have opened or remained open close to middle-income neighborhoods that have transitioned from White to African American. Development of economically disadvantaged African American neighborhoods is critical to effectively prevent diet-related diseases among this population.
The widely publicized violent encounters between police and African American youth have unknown consequences for the emotional and mental health of pregnant African American women. Since studies ...document the hypervigilance black mothers exert to protect children from violence and racism and findings also reveal the association between racial and gendered stress (which includes parenting stressors) and depressive symptoms during pregnancy, an examination of the effects of stress from anticipated negative experiences between black youth and police on maternal mental health is warranted. Between July and August 2014, 100 mostly low income pregnant African American women who lived in metropolitan Atlanta and were in their first and second trimesters completed the Edinburgh postnatal depression scale, selected items from the Jackson, Hogue, Phillips contextualized stress measure, and a demographic form. Bivariate and logistic regression analyses were conducted in response to questions that asked: (1) is the anticipation of negative encounters between black youth and police associated with antenatal depressive symptoms and (2) how does the presence of prior children, male or female, contribute to the association? For question 1, the results showed that anticipated negative African American youth-police experiences were significantly associated with antenatal depressive symptoms
χ
2
(2,
N
= 87) = 12.62,
p
= .002. For question 2, the presence of a preschool-aged male child in the home was significantly associated with antenatal depression (
p
= .009, odds ratio = 13.23). The observed associations between antenatal depressive symptoms and anticipated negative police-youth encounters have implications for clinical- and community-based interventions responding to the unique psychosocial risks for pregnant African American women.
Polyoxymethylene (POM) is a polymer of formaldehyde used inter alia for kitchenware and food processing machines. By migration into food, consumers may be exposed to small additional amounts of ...formaldehyde in food. In order to address such potential exposures, Specific Migration Limits are derived using all studies with oral exposure in mammals and birds. The assessment is not only based on local irritation observed in a 2-year rat study that has previously served to calculate acceptable exposure levels, but also on systemic effects, namely on effects on the kidney in adult rats and testes in birds before sexual maturity. At the relatively high oral exposure levels (up to 2000 ppm in drinking water) long-term effects caused by formic acid, the first step metabolite of formaldehyde, such as acidosis, cannot be excluded. The lowest Specific Migration Limit of 2.74 mg/dm2, corresponding to 16.5 mg formaldehyde/kg food, is based upon kidney effects in rats, leading to potential exposures that range between 2900 and 4400 times below the endogenous turnover of formaldehyde. Lastly, a recent migration study with POM showed that migration of formaldehyde into food simulants is over an order of magnitude below the lowest Specific Migration Limit derived herein.
•Safety assessment for migration of formaldehyde into food from polyoxymethylene.•Derivation of a Specific Migration Limit for formaldehyde by application of assessment factors.•Risk assessment based on local irritation to the stomach and toxicity on kidney in rats and testes in immature birds.•Defining a possible mode of action for systemic effects: acidosis caused by formic acid.•Exposure assessment based on migration of formaldehyde from polyoxymethylene into food simulants.
In 2020, the U.S. EPA initiated TSCA risk evaluations for 20 High Priority chemicals, as required by the Lautenberg Act. In addition to consumer exposures, the evaluations include quantitative ...assessments of worker exposures, hazards and risk. The EPA evaluations of worker exposures, and authority over corrective action to address unacceptably high workplace exposures, overlap OSHA's authority for regulating workplace exposures. This dual federal regulatory authority for risk evaluation and risk management, presents new challenges for industrial hygienists, exposure/risk assessors, and risk managers. One of the chemicals identified as High Priority by the EPA is formaldehyde. In response to these challenges, Celanese supplemented its regular OSHA compliance sampling for formaldehyde with a one-time comprehensive sampling at our sole U.S. formaldehyde manufacturing facility. The sampling characterized all worker populations at the facility, including office workers. Although the EPA assessment is ongoing and may reach different conclusions related to an acceptable exposure limit, 126 full-shift monitoring results demonstrated compliance with the OSHA Formaldehyde Standard (29 CRF 1910.1048) for health protection. Methodologies used to identify workers for exposure monitoring, to characterize multiple EPA-specified worker populations, as well as potential challenges related to the dual regulatory authority for assessing and managing worker exposures are discussed.
•Formaldehyde exposure monitoring at a chemical plant included 126 full-shift samples.•Worker populations categorized as formaldehyde manufacturing, use as an intermediate, and occupational non-users (ONUs).•95th percentile exposures ranged from 0.169 ppm for POM compounding to 0.016 ppm for ONUs.•Median formaldehyde exposures ranged from 0.075 ppm for POM compounding to 0.005 ppm for ONUs.•EPA and OSHA dual mandate for assessing and managing worker risk presents new challenges.
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